Patients with borderline personality disorder (BPD) can develop substantial insight into their interpersonal patterns, abandonment fears, splitting, and family-of-origin dynamics, yet still return to the same maladaptive responses when relational stress intensifies. For psychologists, the clinical challenge is often not helping patients understand the pattern, but identifying what disrupts reflective capacity in the moment and what is required to translate insight into meaningful behavioral change.

This seminar examines John Gunderson’s interpersonal conceptualization of BPD and considers the question: Is BPD fundamentally a relationship disorder? Dr. Fox will guide participants in evaluating evidence supporting and challenging this perspective and examining how abandonment hypersensitivity, rejection sensitivity, and relational activation shape clinical presentation.

The seminar will also focus on how expectations influence perceptions of self, others, relationships, and situations; how splitting can reduce ambiguity and create temporary psychological certainty; and how patients  may cross a relational threshold into shutdown or teardown. Using Dr. Fox’s core and surface content model, participants will examine how to move beneath immediate behavioral reactions to identify the core vulnerabilities organizing the response.

The final portion of the seminar addresses one of the more difficult aspects of BPD treatment: converting insight into impactful behavior change. Participants will examine fear, doubt, the Family in the Head, attachment to familiar maladaptive patterns, and the perceived risk associated with responding differently. Emphasis will be placed on case formulation, timing of intervention, and helping patients move from recognition of the pattern to sustained behavioral change when relational activation occurs.

Learning Objectives

By the end of this seminar, participants will be able to:

1. Evaluate evidence supporting and challenging the conceptualization of borderline personality disorder as a relationship disorder, including Gunderson’s interpersonal model and the roles of abandonment hypersensitivity, rejection sensitivity, and relational activation.
2. Assess how expectations and splitting influence perceptions of self, others, relationships, and situations, and identify when relational activation is approaching a threshold of shutdown or teardown.
3. Apply a core and surface content model to distinguish immediate behavioral reactions from the underlying vulnerabilities organizing the response and guide the timing and focus of intervention.
4. Identify factors that interfere with translating insight into behavioral change, including fear, doubt, the Family in the Head, and attachment to familiar maladaptive patterns, and formulate interventions that support sustained behavioral change.